tv [untitled] June 23, 2011 7:30pm-8:00pm PDT
we know how to have a good time, drug free. so i just wanted to talk to you guys about the talent show and what we are working on. when are we going to do the actual show? is it going to be an in-the-evening performance? an after-school performance? a prevention-prepared community is a group of concerned citizens that come together and meet, and they all have the same focus around substance abuse prevention. any community can decide it is time to make the change, and let's really try to get... let's try to rally around and energize our neighbors to address this before we have the accidents, before we have the traffic crashes, before we lose more young people to substance abuse and all the things that come with that. the coalition is willing to come together and go through training together to make sure that they are looking at the data and the information about their community and
assessing it in the correct way. and then coming up with a plan or a project that addresses their needs. i really like the idea of building the positive. it is sort of like building health instead of treating a disease. some of the specific challenges at a coalition level or a community level: engaging the key leaders, engaging the grandparents, parents of kids, and all of the sectors. bringing them in and then giving each of them a role to play and keeping that engagement over time is also a challenge. our role is facilitation. the conversations take place between the youth and the community members. usually, within these community members there is representation from law enforcement, from the business community, from the faith community, from elected officials, parents, students. i'm not with my 15-year-old 24/7, you know, i'm with her...
i work at the school so i am here, but i don't see her every day. i don't see her in between classes, and it is good that there is reinforcement to back me up, saying, you know, "don't drink, don't use tobacco products." you need to have the prevention to keep... to keep these risk factors either away or down to a minimum with youth. show alternative ways to spend your time, i think that is probably the ideal thing. and prevention is probably a lot easier since you aren't already addicted to anything, then having to quit later and going to rehab. like i always say, i don't want to do that. i want to finish school and go to college. in this club you get to help people and you get to tell people what things not to do, like i have experience with background, like with drugs and stuff, and i don't want to go down that road. i want to go down a different road. so that's why i am in this group. as a community we are after the same goals and knowing that we can work together and we can bring positive change to
the community is always very rewarding. dr. greene, going back to screening and brief interventions, are there certain competencies that need to be highlighted while trying to implement that program? definitely. the cultural competency piece is a specific part of our know the risk sbirt program at howard university. we wanted to make sure that people understood that communicating to one group versus another may require some refinement. you may need to know where the people are coming from, what their background is, so we try to incorporate this through a web-based program, education as well as through lectures and didactics and role playing so that the residents actually get a chance to get a understanding. so, when they come and actually talk to the person, they have some sense of history of who this person may be and why they are. and maybe why they don't want to come and seek treatment. and how is that accepted among the folks that have been
trained in the sbirt methodology? well, the sbirt methodology has, i would say, taken a great role in not only improving the way they communicate for sbirt but all communication. because they have to learn how to talk with patients of different cultures for many different reasons. it may not just be sbirt that they are talking about, but they take these same skills, this open-ended listening and reflective listening, back to their own patient population for other reasons also. and they also incorporate... i know that we were talking about previously the whole issue of families not wanting to accept that there is a mental illness because they feel somehow people may discriminate against them, and some people call it stigma, but it is really a discriminatory practice to not be able to accept the medical condition within the family. so i suspect they need to also learn about those issues. definitely.
learning about the whole spectrum improves the health care provider and what they can provide, what assistance they can provide to their patients. and, fran, let's go back and talk about... most of what we have been referring to has to do with alcohol and drug disorders. how about the mentally ill or the people with mental health problems? is it similar? are we learning to adapt sbirt for that community as well? yes, in particular sbirt now is a billable service under health insurance for screening for depression. and that is a big leap that, combined with parity legislation, that has allowed us now to health insurance, now have to pay for mental health services. both of these may be small steps in some respect are huge steps in our field because it helps take care of that discrimination and helps people become a little bit more accepting. that we are talking about health, major health conditions
that they may be mental health, they may be emotional health. and as a matter of fact... language is important, emotional health transcends to all of what we are talking about today under behavioral health. because if you are emotionally healthy you have a strong character, you have confidence in yourself, your family is emotionally healthy. we're looking at lowering risk for behavioral health problems across the board. and of course our audience needs to realize that under the parity law small businesses of more than 50 people that are already covering certain conditions need to also cover mental health conditions as well, correct? correct, and some of your listeners may not realize that that has not been done before. and that is one of the reasons why parents struggle and why they may not talk to their young people at a younger age simply because they can't afford it. so what would you do as a parent? you have something you can't really talk to anybody about, you don't quite understand it yourself, and your doctor is
saying to you, "well, if you want these services you've to figure out how to pay for it." our whole health care system now is changing and so will the health of our country. jordan, given your experiences and the fact that you speak to parents, that you speak to populations within school systems, what do you think the communities really need to begin to do better in order to address some of these issues? i think that one thing, and i mentioned earlier, was that kids need to feel and young adults need to feel as though they are not the only ones going through what they are. not just by their parents but other people around them of the same age. you know, there was a statistic in the early 2000s, in 2001, 2002, that even though 20 to 25 percent of young adults will suffer from a mental disorder in a given year, up to two thirds of those kids won't seek help. and a lot of that is because of that stigma and the fact that kids don't know if other kids are going through these topics or issues because there's no discussion. and that is what i try and promote
when i go to speak at these schools. not just to talk to each other inside the school but inside the entire community of all ages and to implement programs, whether it is peer mediation between the students or whether it is different activity nights for all ages to again continue the dialogue of mental health. jane, we've talked about screening and brief interventions. talk to us about what the institute does at cadca and how it offers community an opportunity to really get engaged. well, i will try to be brief, ivette, because as you know that is my favorite topic. what we do at the community anti-drug coalition institute is we work with communities throughout the nation to help them become prevention-prepared communities and get all of the different segments of the community working together to not only implement programs but also change systems and policies and practices and environments to once again have a comprehensive approach to these problems.
so, we're more likely as a nation to have communities that are tackling these problems in serious and significant ways, which actually lead to results. and how do you do it? what is done? how can someone contact you and make sure that they have access to the information, to the training. i suspect that you do training. for your audience, you can get in touch with us at cadca, c-a-d-c-a dot o-r-g. go to our web site and all of the information is available there, and what i am really pleased about is the fact that we really do have the capacity and the reach to help communities start what we call community coalitions. and how do they do that? they do that by bringing community members together, different segments of the community together to identify local conditions that are important in their communities to address and then developing strategies where all of the different segments of the community work together to alleviate those problems.
it's what americans do. you know, ivette, when there is a problem you get everybody together and you work together to solve it. and there are ways that you can do it effectively. and what we try to do at the institute is help communities actually do those things effectively. fran, do you have an example of a really good model of, you know, a prevention-prepared community? actually, yes, and jane and i work hand-in-hand on this. in between the federal government and our community coalitions, working through what we call the strategic prevention framework model. and basically what that means is that we teach communities, as jane has already mentioned, to do five different steps. and going in abbreviated version, you want a community to come together just to discuss the problems that they see. do an actual assessment. they're taught how to do that so that they have data. learn how... what to do with that data and prioritize your problem, go after an evidence-based practice that
will mitigate the problem and at least address it. and then, the all-important thing that we didn't used to do on a regular universal level, which is to evaluate what you just did and then you start over again. and this is a process that has been going in our communities on several different types of coalitions, both in family communities, college campus communities, rural, urban, any possible community structure you can think of across the country for the last decade, and it is really showing good results that community change is happening around the topics that we've been talking about here tonight. what are some of those good results? reduction in underage drinking. between the ages of 8 and 16 we are reducing the use of alcohol among our young people. however, we are seeing an increase between the ages of 17 and 20, 21.
so that's a problem area for us, and we are working with our communities, and that is something that jane would take in her training and highlight. suicide prevention, suicide prevention going through this type of a model also is raising the awareness. we have over 4,000 young people each year die of suicide. now what is equally important is that from each suicide, each one of those 4,000 has anywhere from 1 to 200 attempts. so this is a major problem. a community, when they assess, and they have had a couple of suicides of young people in their... or older adults in their community, then they will target a program directed to that. we are seeing results of that as well. well, when we come back i want to go back to talking about some of the other programs that exist, and i want to see what... how hospitals and how youth organizations can also get in the mix to solve all of these problems.
we'll be right back. for more information on national recovery month , to find out how to get involved, or to locate an event near you, visit the recovery month web site at recoverymonth.gov. they tell me i was there but i don't remember. i don't know where i really was. i do not know what i had for breakfast. i do not know who won the game. i don't recognize this man. if you or someone you know is struggling with a drug or alcohol problem, there is a solution. recovery. call 1-800-662-help for information and for hope. through treatment my life's a whole lot brighter now. brought to you by the u.s. department of health and human services [music]
so, screening and brief intervention is what we call a secondary prevention approach. so, it is a way of intercepting people who might be already engaging in risky substance abuse behavior and trying to reduce their abuse and reduce the harm that they might experience from their substance use. we decided to do our intervention in this mental health clinic. and that's something that hadn't been done before, so we decided to use this very brief screening and brief intervention tool called the assist. it is the alcohol smoking and substance involvement screening test, which was developed by the world health organization. well, we use the assist results in intervention planning quite immediately; that is part of the beauty of the assist, that it has kind of a built-in intervention that, based on the score
that is deduced from the eight questions of the assist, you are kind of guided to do a validating response, a brief intervention, or an intervention with kind of a referral to treatment or a discussion about kind of getting further treatment. and in that assist they'll provide much more detailed information on their pattern of usage of various substances. we have a fair amount of detail that we end up with as a result of their completing the computerized assist. one of the things we use with the assist results is kind of looking at how maybe the substance use is impacting the current... their presenting issues. if it is depression or anxiety, maybe how the substance use is exacerbating that, and we will give some education about that, the risk factors, and then we will also explore the consequences with respect to the presenting concerns. over the course of counseling, we will actively look at the student's ambivalence or values with respect to the substance use as it relates to the presenting concerns. well, our program here, i think, is a really great
resource for ucla. not only do the students here benefit from the screening and brief intervention services, but the health center here on campus is referring students here who they feel might be at risk for substance use. one of the lessons we learned from the research we did here was that for students who really have a high score on the assist, who are at risk for what we call chemical dependency. it is very hard to convince someone that, just because they are having a lot of negative consequences from what they are doing, that they should get treatment for that. so we really needed an intermediary step; you know, no matter how at risk they are, most people... it is a hallmark of substance abuse if they just don't feel that at risk. when we recognize that a student requires more extensive treatment or intervention related to a chemical dependency issue, we collaborate with a substance abuse and dependence treatment facility that is actually located near campus, named the matrix institute, and it is also covered under the student health insurance plan.
we also need to address the broader environment. so we need to look at ways of making alcohol and drugs less accessible to students, and so it is very important to have the one-on-one interventions, but also to have the broader environmental strategies and policy strategies to address this problem comprehensively. dr. greene, we were talking about certain prevention-prepared communities. within that can you talk a little bit about what role hospitals... and you know-and we are using howard university hospital as an example-are doing or should be doing in order to engage in these efforts? i am glad you asked that question, ivette. the hospital has suicide prevention, suicide groups as well as recover... people who have recovered from post-traumatic stress disorder. so there are some groups to help and address some of these issues, but there is still a larger community that we need to get help to.
the identifying and screening, not only for just substance abuse but for the mental health that jordan was talking about previously so you can identify patients a little earlier. you start seeing the patterns: this person got shot last year, now they got shot this year, they're under the age of 17 and as a trend may go... that third time may be a fatal one. so getting the family involved, getting the child protective services, getting our community involved to really try to address some of the greater issues that may be going on and not just putting the patient right back out on the street, but you need resources and an organized community and support system. you may be able to identify it, but if you can't send the patient anywhere to get that help, your identification becomes a stopping point. so we really want to encourage the acquisition of more resources. similarly, with our sbirt program we have a great apra-system but because of our inability...
what is an apra-system? apra is our intake center that helps to send patients who need to go into a recovery program; whatever the recovery program may be, it helps to identify beds that are open in the city. what we would like to do is to really be able to have that interposition point, somewhere where you can take the person in so they don't have to go back out on the street before they can get into the intake system. very good. our concerns are that we may be losing people. they may have agreed to go into the system, but they had to go back out on the street first and now they didn't come back. so we feel... and then the beds may not be available for a long time, and that becomes a concern for us also. jordan, as a person who went through the system and had support, in the ideal world, what would you have preferred to have had in order for you to not have, you know, not go through what you went through. i wish it didn't take a suicide attempt like myself to have to get to the point where i wanted to be,
support systemwise. one thing that i truly benefited from that is different from before my suicide attempt is that i have one psychiatrist. before, i had a therapist and a psychiatrist. therapist was very warm, was there to hear you talk; the psychiatrist was not very warm and was there to administer medicine. there was a lack of communication between the two as far as what medicine, i should be taking, whether it was the right dosage. something i truly see as a benefit now is having a psychiatrist who is both my therapist and administers my medicine which truly again is something that helps me emotionally and mentally, knowing that there is never going to be a lapse in that communication. let's shift a little bit, fran, and talk about some of the recent research. what is it telling us that we still need to do in the area of early intervention and prevention? we need to spend more time in really figuring out what are some of the signs and symptoms of diagnosing mental illness in particular. we now know that by age 14 we can begin to see the signs of
mental illnesses, depression, anxiety, and even schizophrenia at that age, some signs. those signs also... we also have just recently learned that there are other signs that start to appear to give us a little insight around 2 to 3 years earlier, so we're really starting to reach in to those younger populations. we also need to balance out the brain disease part of mental health-mental illness, rather-and see what can we do about that, like, and learn from the substance abuse world of their issues with looking at how the brain interacts with our enzymes, which interacts with the disease itself. as with most chronic illnesses, even though we have come so far with addictions and in mental illness we still are not at the same level of knowledge and expertise that we are with learning about diabetes and cancer and heart disease
and even alzheimer's disease. so we have come a long way, but we have a lot longer to go to be able to get this to a level where all physicians, like dr. greene, who understands the behavioral health issues and understands addictions. so it becomes just one of the many physical health issues that we look at. and within the context of samhsa and the strategic initiatives, where is that going to take us to further the science? well, samhsa has eight strategic initiatives. we are focusing on everything from prevention right straight through to several different populations. we are looking at trauma and justice issues. we are looking at the military, because the military right now and the military families are really using the services that we have and are showing signs of both mental illness issues around depression and anxiety and suicide as well as addiction.
and we know a little bit more about addiction, but we are really learning now some of the other areas of mental health. we're also focusing in on health electronics, technology so that we can start to speak to each other across all systems. so the doctors, physical doctors can talk to your psychiatrist. and we can ... and therapists can talk to other therapists, not only in the united states but across the world where there has been some other advances. and we're doing several other issues. we are looking at the recovery, which i know that you... this is why we are all here, to look further into what does recovery really talk about and then... and the last but certainly not least... and certainly i haven't told you all of them but public education and communication. we are jumping into the new media realm so that we can reach the youngest of young and the oldest of old. so we will do traditional tv commercials and we will do
traditional radio spots but we also are on our computers and we are on our laptops and young kids, we are on their telephones. so we are twittering and tweeting and facebooking and blogging and all the rest because we must get this information out to everybody. yes, indeed. jane, in terms of the institute... beyond the prevention-prepared communities, what other exciting areas are we looking at within the institute? well, a couple of things that we are really excited about is, we are about to hold our 21st annual leadership forum and at that conference, which is a really large conference of people who are involved in this work in their communities, we are going to be recognizing communities that have done an exceptional job of doing what we talked about earlier, which is putting together strong community coalitions. so i'm very excited about that. i am also excited about the fact that we've been working
really hard to bring community coalitions and the research community together and do what we call community-based participatory research. i think, as everybody knows, there is lots of really good research out there about what works and what doesn't work but that doesn't always filter down to communities. well, the communities need to know about it. it is useful and helpful so, by combining researchers and communities working together where they're working in partnership, we really increase the likelihood of first getting those best practices down to communities, but secondly forming the research agenda or informing the research agenda so researchers can put together research that is relevant for communities. so that is just a couple of things i am real excited about. and the results get down to someone like jordan who is out talking to the schools. why is it important, jordan? i want you to make that broadly known. why is it important for schools to have individuals like yourself go and speak to the student body and speak to parents? i think it's important to have, you know, someone speak on
mental health, like myself to go into schools basically to generate and to start a conversation. because what i think happens is there is a conversation started and that generates a lot of attention and from that attention that is when the education begins. and that is what i like to do, is just to plant a seed when i go to speak at those schools so that the kids there, the parents there, the teachers there have something to think about. and the goal is that, when i get home at the end of the day after speaking to that school, they're just not talking about those mental heaealth issues and topics the next day, the next week, the next month, but for months and years after that. and that is why i think it's important, like active minds, the organization that i speak for, there's over 300 new branches over the entire country and that's for young adults to express how they feel, to tell their own stories, and to feel like they truly belong in the mental health community. and i think it's great. very good. fran, final thoughts? collaboration. i think that most of what we are talking about here is collaboration. we cannot do it alone, we have to work with our... at
the federal level we're working with all our federal partners, everything from a prescription drug abuse problem with the federal drug administration; we're working with the office of national drug control policy on some of our substance abuse issues, particularly targeting young people and older adults. we're also looking, working with the centers for disease control. we're just working and working with our partners. we're asking states to do exactly the same thing. we want to give out the messages that we are trying to bring behavioral health into the primary world of health. meaning, and in a much simpler way, bringing substance abuse and mental health issues to the world of physical health. dr. greene, final thoughts? i would like to just say that promoting the community think tanks such as dc rock and other such initiatives that are there to help and provide additional services, they address needs... are a way for us to combine the health care
professionals to outside community organizations so we aren't out there alone. there are other people who are working on these initiatives, and we need to combine our efforts. jane, final thoughts? one final thought: i think it's really helpful when communities have people like jordan and wendy, our doctor, involved in these kinds of efforts. it's so essential to have young people become good community problem solvers and its really, really important to have our professionals in the community working on these problems, not only from a programmatic aspect but from a systems change and policy aspect because we all know there's good programs out there, but it's really necessary to take them to scale and institutionalize them. very good. and if communities want to get engaged and involved, there's no better opportunity than to do so during national recovery month . recovery month is celebrated every september. there are materials online that you can use, and it's really
looked at and prepared all year round, so you can get engaged in recovery month all year round. we hope that you do so, and we hope that you continue to spread the word that prevention works, treatment is effective, and recovery is possible. thank you for being with us. for a copy of this program or other programs in the road to recovery series, call samhsa at 1-800-662-help or order online at recoverymonth.gov and click "multimedia." every september, national recovery month provides an opportunity for communities like yours to raise awareness of substance use and mental health problems, to highlight the effectiveness of treatment and that people can and do recover. in order to help you plan events and activities in